Volunteer Application
Thank you for your willingness to volunteer with The Grief Center! Please fill out the form below and our Community Relations Director (that's Carolyn!) will reach out to you with volunteer opportunities that fit your interests and abilities.
Name *
First and last name
Your answer
Maiden Name (if applicable)
Your answer
Email *
Your answer
Phone number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address (Street, City, State, Zip) *
Your answer
Ethnicity *
Required
Driver License Number *
Your answer
Social Security Number *
Your answer
Place of Employment *
Your answer
Emergency Contact (Name, Phone) *
Your answer
Do you have any physical limitations? *
If you answered 'Yes' to the question above, please explain:
Your answer
Have you ever been treated for psychiatric illness, alcohol abuse or drug abuse? *
If you answered 'Yes' to the question above, please explain:
Your answer
Have you ever been charged with, pleaded guilty to, or been convicted of a criminal offense? *
If you answered 'Yes' to the question above, please explain:
Your answer
How did you hear about The Grief Center?
Why would you like to volunteer with us?
Your answer
Have you had a death loss within the last year? *
If yes, whom did you lose?
Have you had a major death loss within your lifetime? *
If yes, whom did you lose?
Did you experience a major death loss during your childhood? *
If yes, whom did you lose?
What age were you?
Your answer
Please list any education, employment, or experiences that you feel would relate to volunteer work with The Grief Center:
Your answer
Are you bilingual?
If yes, what language?
Your answer
What days and times would you be available for volunteer work?
Morning
Afternoon
Evening
All Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please select all volunteer activities that interest you: *
Required
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